| NPI | 1649733239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101281595) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2023-06182) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2023-01682) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-08-01 |