| NPI | 1164126389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 81688-21) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 8168821) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2026-07-16 |