| NPI | 1831503846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 291628) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX bp10049488) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-05-05 |