| NPI | 1114423779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 68729) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 295574) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-08-14 |