| NPI | 1821521295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301501693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301501693) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-08-19 |