| NPI | 1275027419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T5494) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301115482) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2022-03-03 |