| NPI | 1740930957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 13539244-1205) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-07-03 |