| NPI | 1720024870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 51407-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: TN md0000046018) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2011-07-12 |