| NPI | 1205464112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1019028) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.250089) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2024-06-16 |