| NPI | 1235495870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 6010) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX Q4620) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10042694) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2023-01-20 |