| NPI | 1720513054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 042-0016387) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 227315) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-10-26 |