| NPI | 1083938336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP60394009) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR DO167698) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10034213) | |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2022-09-14 |