| NPI | 1730641507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 19937) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.030632) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-03-25 |