| NPI | 1073203865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX BP10084371) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX P10084371) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-31 |