| NPI | 1649856329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 78563) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME TP21005) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-07-08 |