| NPI | 1871980326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WV 29681) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 209644) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2022-04-08 |