| NPI | 1255743290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 67533) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101264811) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2022-02-09 |