| NPI | 1992201883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OT020297) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2020-09-20 |