| NPI | 1295184042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101262997) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2016-06-11 |
| Last Update Date | 2025-03-04 |