| NPI | 1750618617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 78398) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 6571) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2018-04-19 |