| NPI | 1871054346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A20942) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125.074915) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.074915) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2023-12-26 |