| NPI | 1376930438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 290477) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ U97586027601882) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2021-12-20 |