| NPI | 1306289632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD181009) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML60362037) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60362037) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2018-10-19 |