| NPI | 1629507017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A147319) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A147319) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-12-17 |