| NPI | 1861750853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA R-09509) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 65424-21) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2021-12-30 |