| NPI | 1407316011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V0471) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10070873) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-04-25 |