| NPI | 1295896322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101242173) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101242173) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-06-14 |