| NPI | 1508073891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OK 35471) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA md439111) |
| 207L00000X Anesthesiology (Licence: OK 35471) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: PA MD439111) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-06-22 |