| NPI | 1285832659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 43010090303) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.099175) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 35.099175) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2021-03-24 |