| NPI | 1528486974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 54749) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301119044) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2023-07-24 |