| NPI | 1598028508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 90070) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 262131) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN17815) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-11-23 |