| NPI | 1215425665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 65432) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2021-00236) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 238546) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2022-05-26 |