| NPI | 1609221209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA 88902) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: GA 88902) | |
| 207L00000X Anesthesiology (Licence: MA 279282) | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2022-06-28 |