| NPI | 1447519350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A129341) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN# 17143) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2022-07-21 |