| NPI | 1922446319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2015-00633) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 193098) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2023-06-21 |