| NPI | 1164089694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019069) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OS023736) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2024-07-09 |