| NPI | 1629339965 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: AZ 47694) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 47694) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-04 | 
| Last Update Date | 2023-08-28 |