| NPI | 1386224731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 81355) |
| Additional Taxonomies | 208VP0000X (Licence: WI 81355) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2026-07-26 |