| NPI | 1457619710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12385608-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX Q7573) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2021-07-19 |