| NPI | 1932545506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2017-00285) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 192071) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2021-02-12 |