| NPI | 1962762278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology Critical Care Medicine (Licence: TX Q8727) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX Q8727) |
| 207R00000X Internal Medicine (Licence: TX Q8727) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2020-12-21 |