| NPI | 1881184463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1017674) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 238729) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2024-06-28 |