| NPI | 1972038438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 87486) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 227293) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2024-07-17 |