| NPI | 1215469739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 333681) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA11114600) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2025-05-14 |