| NPI | 1649537507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D84533) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 26455) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2022-04-08 |