| NPI | 1073020715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME156429) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME156429) |
| 171000000X Military Health Care Provider (Licence: VA 0101267660) | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2023-08-29 |