| NPI | 1326690405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 92109) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT219283) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 3013531) | |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2024-10-01 |