| NPI | 1689867178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 53924) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60215737) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019814) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2021-03-26 |