| NPI | 1598086118 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0053965)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.058474)  | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-17 | 
| Last Update Date | 2021-03-17 |