| NPI | 1013409184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 312799) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MB11737900) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2024-12-02 |