| NPI | 1740674142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 298514) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63576) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2019-11-12 |