| NPI | 1063040897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA MD-57105) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351050251) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2026-06-19 |