| NPI | 1548791577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX U3886) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 183500000X Pharmacist (Licence: CA 74835) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2024-05-09 |