| NPI | 1144740507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301508177) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.144857) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2024-06-18 |