| NPI | 1780260596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 104715) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.250502) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-06-24 |