| NPI | 1386089324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 04136) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 123456) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2022-07-21 |