| NPI | 1184037863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KS 04-49483) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 57.247375) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: KY 54866) | |
| 207L00000X Anesthesiology (Licence: MO 2024028587) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2024-07-23 |