| NPI | 1003159666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 286981) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 9164175-1205) |
| 207L00000X Anesthesiology (Licence: FL ME142928) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207L00000X Anesthesiology (Licence: TN 57494) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2023-07-18 |