| NPI | 1659733038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 310291) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.138068) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2021-05-09 |