| NPI | 1487115440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 75284-21) |
| Additional Taxonomies | 229N00000X Anaplastologist (Licence: WI 75284-21) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 75284-21) | |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2024-05-13 |