| NPI | 1265612071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA 60085548) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60085548) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2019-05-08 |