| NPI | 1700013752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 130185) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD162175) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML 60096997) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2015-01-30 |