| NPI | 1023435476 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 81728) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 291705) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-24 | 
| Last Update Date | 2025-06-04 |