| NPI | 1659531465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA C165866) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101245974) |
| 208D00000X General Practice (Licence: OK 29412) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2020-02-06 |