| NPI | 1174941454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S0968) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125066166) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: IL 125-066166) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2020-02-13 |