| NPI | 1871112565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 32692) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX V2428) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-07-10 |