| NPI | 1972821965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY R2495) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AR E-8510) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2017-08-03 |