| NPI | 1669869764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101261028) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 171000000X Military Health Care Provider (Licence: VA 0101261028) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-03-11 |