| NPI | 1679007264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS17764) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 009010) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2025-04-09 |