| NPI | 1336700269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2024-00984) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NC 2024-00984) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044081) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-09-17 |