| NPI | 1225499445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101262944) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: VA 0101262944) | |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2024-08-22 |