| NPI | 1538817226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101280415) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: VA 0101280415) | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-03-12 |
| Last Update Date | 2026-06-10 |