| NPI | 1295115673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 14945) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2024-08-28 |