| NPI | 1154815090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301509461) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301114801) |
| 207L00000X Anesthesiology (Licence: KY C4664) | |
| 207L00000X Anesthesiology (Licence: CO CDR.0006061) | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2026-04-09 |