| NPI | 1760688139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR md156674) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA mt190037) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2016-05-11 |