| NPI | 1669863064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0071110) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 29806) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-07 |
| Last Update Date | 2023-06-15 |