| NPI | 1043739873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD213564) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 98939) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2023-12-27 |