| NPI | 1720499981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2019024440) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 049753251) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2019-08-01 |