| NPI | 1124472352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2021019933) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 61047387) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2021-09-28 |