| NPI | 1023464302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 63288) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.028160) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2022-03-31 |