| NPI | 1841582400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 59907) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 43011099084) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2018-04-16 |