| NPI | 1942704556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WY 14525A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-67464) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2022-06-11 |