| NPI | 1144725862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MO 2024037990) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 61308547) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-09-26 |