| NPI | 1972162246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS19717) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL UO6596) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2023-12-19 |