| NPI | 1710626841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX W4102) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151015858APP22) | |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2026-02-28 |