| NPI | 1801319058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V3706) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA FS2328222-79) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2025-08-05 |