| NPI | 1235584186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.139665) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125069837) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2020-07-13 |