| NPI | 1164876611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2021-02795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125068638) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207L00000X Anesthesiology (Licence: IL 125068638) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2022-07-05 |