| NPI | 1679912000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-02172) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 192897) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2023-08-31 |