| NPI | 1215638242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 339730) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: NY 339730-01) | |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2025-09-20 |