| NPI | 1700164779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AR E9968) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: TX BP1-0040866) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2016-11-07 |