| NPI | 1376006296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A184305) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: MN 81064) | |
| 207L00000X Anesthesiology (Licence: PA MD484633) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2026-04-20 |