| NPI | 1093059040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R6629) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 53831) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2022-08-09 |