| NPI | 1720374622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 125068) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301115583) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2018-07-11 |