| NPI | 1689165367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 185249) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 185249) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2024-08-14 |