| NPI | 1114216041 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: TX q8866) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| 207L00000X Anesthesiology (Licence: TX q8866) | |
| Enumeration Date | 2011-03-31 | 
| Last Update Date | 2016-07-29 |