| NPI | 1346697174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301504549) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD471145) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI MT211095) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2021-07-02 |