| NPI | 1730400516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2012-01209) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 52747) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 165574) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2019-11-13 |