| NPI | 1720649031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX U4812) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125-075236) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2023-09-26 |