| NPI | 1114458494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 1.076857) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57030320) |
| 207L00000X Anesthesiology (Licence: OH 35.141652) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-02-05 |