| NPI | 1134382989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 11041396-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 48793) |
| 207L00000X Anesthesiology (Licence: IN 01071013A) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10031385) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN14461) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2021-04-06 |