| NPI | 1740505296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 289046-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: None) |
| Enumeration Date | 2010-03-27 |
| Last Update Date | 2019-10-06 |