| NPI | 1306472253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 13861668-1205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-88117) | |
| Enumeration Date | 2020-03-22 |
| Last Update Date | 2024-04-17 |