| NPI | 1669765285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 010397) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 330512) |
| 207L00000X Anesthesiology (Licence: ID O-0686) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2024-03-07 |