| NPI | 1255781225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 63039) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: CT 63039) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 268546) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-06-06 |