| NPI | 1972894541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 122765) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX Q8076) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2019-08-01 |