| NPI | 1861050932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.144092) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0008432) |
| 207L00000X Anesthesiology (Licence: AZ R77506) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2022-10-28 |