| NPI | 1649430026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY P73032) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301098090) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2019-10-30 |