| NPI | 1568965838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102205754) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102205754) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2024-10-15 |