NPI | 1184202939 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: NY 337735) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2021-04-01 |
Last Update Date | 2025-08-14 |