| NPI | 1760788251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12644961-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR DO197429) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2022-10-19 |