| NPI | 1952966814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 73969) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 333732) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-03-25 |