| NPI | 1154889053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ME DO4017) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151014781) |
| Enumeration Date | 2019-03-09 |
| Last Update Date | 2025-11-13 |