| NPI | 1174779326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL do1097) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AL do1097) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2024-04-23 |