| NPI | 1255656005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 10724851-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 15911) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2018-05-10 |