| NPI | 1437561925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 303109) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA PGY.202349) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2018-08-13 |