| NPI | 1700401395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 321876) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT221373) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-08-15 |