| NPI | 1588892962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP60774008) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P7645) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2009015671) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2017-10-04 |