| NPI | 1013574706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: RI LP05937) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101270694) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-07-03 |