| NPI | 1700371424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 72617) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301115816) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2023-11-01 |