| NPI | 1528454980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 265734) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: AL MD.36314) |
| 171000000X Military Health Care Provider (Licence: NE 29533) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2020-07-22 |