| NPI | 1326277997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0054098) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT 194617) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-04 |
| Last Update Date | 2015-04-05 |