| NPI | 1699041004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101271369) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 87561) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2025-02-12 |