| NPI | 1710253810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12503048-8904) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 006903) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2022-10-11 |