| NPI | 1962666982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 53606) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 69467) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2021-07-09 |