| NPI | 1922363142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 260816) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11016499A) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2016-01-15 |