| NPI | 1003251133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD183342) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60778548) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2025-11-12 |