| NPI | 1104566132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IL 125.081115) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.081115) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2023-11-03 |