| NPI | 1245792621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2023026894) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 75289-20) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-11-21 |