| NPI | 1578548277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IN 01055039A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01055039A) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-01-28 |