| NPI | 1982750519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 51361-020) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1710) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2014-01-23 |