| NPI | 1962727636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 080677) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101022145) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 5101022145) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2018-11-13 |