| NPI | 1275795544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 141042) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101249098) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2012-06-22 |