| NPI | 1659537447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 7469993-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ND 21268) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301092380) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2025-04-28 |