| NPI | 1891084562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60776379) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD177092) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2021-04-05 |