| NPI | 1225495831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101262884) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 01012628844) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2023-06-30 |