| NPI | 1649733239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2023-06182) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2023-01682) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2023-06-17 |