| NPI | 1972731792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ME MD19690) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT194181) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194181) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2016-12-24 |