| NPI | 1316144561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL MD.28800) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2005020368) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2009-06-15 |