| NPI | 1396372454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2024009247) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: OH 58.031405) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-11-19 |