| NPI | 1992192389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2020036065) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 65501) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2020-11-02 |