| NPI | 1265847511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 320092) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 059204) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 64197) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2023-06-09 |