| NPI | 1063887396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 320877) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125.074279) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2025-08-20 |