| NPI | 1790050037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA 78694) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: GA 78694) | |
| 208D00000X General Practice (Licence: LA MD.206360) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2026-07-22 |