| NPI | 1497093082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 42349) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2022-09-13 |