| NPI | 1659598738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 0420012469) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101249348) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901018572) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2013-06-07 |