| NPI | 1467689687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX Q5520) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101251470) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116021581) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2020-07-14 |