| NPI | 1225659139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2020018350) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2020018350) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2020-08-26 |