| NPI | 1598925125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2011-01585) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 34395) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 149034) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2018-03-27 |