| NPI | 1376706911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60206234) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT190157) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2015-12-03 |