| NPI | 1912435199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 58741) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 58741) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2024-06-29 |