| NPI | 1508213745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2024-00544) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 63379) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2024-09-17 |