| NPI | 1073176228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0072967) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OS023382) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-07-16 |