| NPI | 1417311416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 303759) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-02-02 |