| NPI | 1710243001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS018663) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 324100) |
| 207L00000X Anesthesiology (Licence: CA 15759) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2023-07-10 |