| NPI | 1154775997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR DO214935) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 72353) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 72353) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-09-25 |