| NPI | 1629393335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ID M-13403) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 105758) |
| 207L00000X Anesthesiology (Licence: MN 54442) | |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: OR MD171345) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2020-01-15 |