| NPI | 1578293122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 6941) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA HS000288L) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2026-07-01 |