| NPI | 1457411993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 274890) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2014-05-28 |