| NPI | 1174184006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2025-0705) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NC 2025-0705) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044762) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2025-08-05 |