| NPI | 1689293839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 010948) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 34.016184) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 00000000000000000000) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2024-05-15 |