| NPI | 1073016887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.146078.mil) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC 2020-02073) |
| Enumeration Date | 2018-03-18 |
| Last Update Date | 2024-02-08 |