| NPI | 1457767691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 59573) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 58214) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 26315) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2022-05-03 |