| NPI | 1881125367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301504789) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.152132) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2025-02-12 |