| NPI | 1619097920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2014-01583) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 52126) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301087429) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2019-03-05 |