| NPI | 1992140339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 207999) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA PGY) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2021-03-17 |