| NPI | 1104320597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP61420516) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125075187) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: WA OP61420516) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: PA OS022068) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-07-07 |