| NPI | 1649808064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A201828) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036175504) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.077284) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2026-01-26 |