| NPI | 1235573775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 61912) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301102591) |
| 207L00000X Anesthesiology (Licence: IL 125.065454) | |
| Enumeration Date | 2013-04-27 |
| Last Update Date | 2020-09-30 |