| NPI | 1497213649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101270269) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101270269) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2023-06-30 |