| NPI | 1063845444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2020-04029) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: SC 90685) | |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2023-10-20 |