| NPI | 1477073369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A157251) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-07-08 |