| NPI | 1134530272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2020-02067) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 276603) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2024-09-20 |