| NPI | 1265881494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 62111) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 265687) |
| 207L00000X Anesthesiology (Licence: MA 265687) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-07-21 |