| NPI | 1801230750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS21063) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MB12270700) |
| 207L00000X Anesthesiology (Licence: NY 287459) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2025-04-18 |