| NPI | 1487862173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS10131) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0102201626) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2008-05-20 |