| NPI | 1922677459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301515022) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047743) |
| Enumeration Date | 2021-06-19 |
| Last Update Date | 2025-08-04 |