| NPI | 1316393838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: CA A172718) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-11-02 |