| NPI | 1124604194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1022935) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2021020365) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-06-22 |