| NPI | 1932633641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61241829) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 227076) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-08-01 |