| NPI | 1831482660 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 59712) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2020-11-19 |