| NPI | 1215462825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A19014) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2025-12-28 |