| 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 |