| NPI | 1780028654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R3184) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA ML60479110) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2020-06-12 |