| NPI | 1346773702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 315597) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA A66067276) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2022-03-23 |