| NPI | 1215464268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12994458-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO DR.0065653) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-20 |
| Last Update Date | 2022-11-30 |