| NPI | 1619231768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0060071) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R2160) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2018-05-03 |