| NPI | 1881123941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2023-02234) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125070741) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2024-03-27 |