| NPI | 1417341918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 70431) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: MD D88944) | |
| 207L00000X Anesthesiology (Licence: MD D88944) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2023-07-03 |