| NPI | 1376126417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2024-00630) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC DAVI-6UVG6T) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2024-04-18 |