| NPI | 1760970487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2023-01341) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 238352) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2023-05-18 |