| NPI | 1255872677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A157221) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA E1338991) |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2022-06-02 |