| NPI | 1881271948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1027394) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML61164831) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2026-05-14 |