| NPI | 1336527548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME129050) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME129050) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2024-07-18 |