| NPI | 1285861757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 39156) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 069652) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2023-06-04 |