| NPI | 1609142223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 305358) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX R3736) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2018-10-17 |