| NPI | 1497194062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 73505) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA MD.207094) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2021-08-17 |