| NPI | 1518532019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 1003989690) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047847) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-11-04 |