| NPI | 1750585246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 34605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: NC 2017-01362) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2017-08-21 |