| NPI | 1447646484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 73570-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301119053) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2021-02-04 |