| NPI | 1497997977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 2740681) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO DR.0069252) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 230844) | |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2023-03-03 |