| NPI | 1619504180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 2501) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: NE 2501) | |
| 207L00000X Anesthesiology (Licence: NC 2025-00334) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-05-08 |