| NPI | 1700164779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX 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 | 2026-04-23 |