| NPI | 1699017954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX U1283) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 34.012741) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2025-07-30 |