| NPI | 1497142061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 010985) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: MI 5101021870) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2024-05-09 |