| NPI | 1558790576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX W0385) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 57425) |
| 207L00000X Anesthesiology (Licence: FL ME155309) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2025-09-25 |