| NPI | 1639178700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA CRNA-0024000039) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA RN-0001127081) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2015-03-20 |