| NPI | 1710331996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301512190) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME144115) |
| 207L00000X Anesthesiology (Licence: OH 35.152753) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2025-03-19 |