| NPI | 1083387518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IL 125.078698) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.260962) |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2026-07-01 |