| NPI | 1588126916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NJ 25MA12196800) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA12196800) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2024-06-19 |