| NPI | 1861807653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60864179) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60563871) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0005373) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2019-02-27 |