| NPI | 1891992863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301090628) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 43011090628) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2026-06-01 |