| NPI | 1003375890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 85545-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 93447) |
| 207L00000X Anesthesiology (Licence: FL 161667) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-05-05 |