| NPI | 1588648661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 35094-020) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 570228) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2022-03-09 |