| NPI | 1588018634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 310510) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125.069792) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT219807) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2021-07-26 |