| NPI | 1013370642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX R5166) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX R5166) |
| 208D00000X General Practice (Licence: TX R5166) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2021-07-07 |