| NPI | 1750793535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MS 23919) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207L00000X Anesthesiology (Licence: VT 032-0133890) | |
| 208D00000X General Practice (Licence: MS 23919) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2020-02-25 |