| NPI | 1881268613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP61663890) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151015223) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-07-23 |