| NPI | 1386133999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 5101026681) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101023883) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101023883) | |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2022-05-13 |