| NPI | 1588807911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 53261) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 102641) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2025-03-19 |