| NPI | 1295069680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD449925) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2023037327) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2023-12-06 |