| NPI | 1689194672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP61149885) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 1689194672) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2021-05-19 |