| NPI | 1649857871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 45505) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64429) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-07-14 |