| NPI | 1083091649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX 727019) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207L00000X Anesthesiology (Licence: LA 303327) | |
| 208D00000X General Practice (Licence: LA 303327) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2022-10-13 |