| NPI | 1629077193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA CRNA-0024164722) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA RN-0001152041) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2018-03-17 |