| NPI | 1811197262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 265131) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 50944) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2023-01-05 |