| NPI | 1639380546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: AZ 65816) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R78457) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-09-23 |