| NPI | 1821558602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 34.017296) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 58.030696) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-09-23 |