| NPI | 1750947552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX u4306) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: MI 5101025870) | |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-08-03 |