| NPI | 1679748636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 42801) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 127953) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2009-12-22 |