| NPI | 1487274767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1021279) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 329526-01) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-05-05 |