| NPI | 1821315169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R8273) |
| Additional Taxonomies | 207LC0200X Anesthesiology Critical Care Medicine (Licence: KY TP258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2022-07-22 |