| NPI | 1780975672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD459771) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT198995) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT198995) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2023-10-06 |