NPI | 1649633843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 304961) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-04-04 |
Last Update Date | 2021-01-20 |