| NPI | 1205320421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MI 4301509226) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.253032) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301115069) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-09-13 |