| NPI | 1477971596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60847667) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125064641) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2020-05-11 |