| NPI | 1457856676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T7716) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 74662) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2025-01-08 |