| NPI | 1154506947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D94463) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD P21865) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2022-07-13 |