| NPI | 1902290356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 57.026070) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 118711) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2023-02-10 |