| NPI | 1477146306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102207576) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102207576) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2025-12-15 |