| NPI | 1790101566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 8152-851) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1350) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2022-04-28 |