| NPI | 1366738601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 201501004) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 173046) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2015-07-25 |