| NPI | 1164956173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102207877) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: PA OS019336) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2024-01-31 |