| NPI | 1154941805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101027154) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2023-11-30 |