| NPI | 1497136683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61015144) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2015017277) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2020-06-29 |