| NPI | 1760903611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101278909) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD61137359) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 272676) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2023-09-06 |