| NPI | 1568896405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2019-01528) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 226694) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2021-07-07 |