| NPI | 1467013391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 75550) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 8120-851) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2021-06-30 |