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 |