| NPI | 1215564794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2024-01281) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2014-01281) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-11-07 |