| NPI | 1760740526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A14399) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R2977) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2016-08-06 |