NPI | 1003077769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207L00000X Anesthesiology (Licence: ND 12344) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10032227) |
Enumeration Date | 2008-06-24 |
Last Update Date | 2022-01-20 |