| NPI | 1962847558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 79979) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125-064327) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2018-06-26 |