| NPI | 1265993349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1022092) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 23796) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2025-04-21 |