| NPI | 1578149738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102207375) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2025-07-09 |