| NPI | 1871154708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 5101028142) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151013424) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-08-22 |