| NPI | 1710560214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NM DO2026-0123) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2022-0820) |
| 207L00000X Anesthesiology (Licence: CA 20A23879) | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2026-07-23 |