| NPI | 1265059976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D0100562) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT221946) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2024-11-13 |