| NPI | 1407116296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-01433) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: DE C1-0012106) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182580) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2024-09-17 |