| NPI | 1518594589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OL61066914) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA OL61066914) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2021-06-08 |