| NPI | 1942566740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 076305) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102205062) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2023-04-27 |