| NPI | 1356578991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 201300968) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 156917) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 156917) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2023-03-23 |