| NPI | 1508639857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 60-P124105-01) |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-07-22 |