| NPI | 1427704162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 209395) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 8277820) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2026-06-23 |