| NPI | 1356649206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T2983) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: VA 0101252987) | |
| 207L00000X Anesthesiology (Licence: GA 76183) | |
| 208D00000X General Practice (Licence: VA 0101252987) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2023-05-24 |