| NPI | 1083904866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 55838) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 106267) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2020-08-04 |