NPI | 1689177826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A22730) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102205752) |
Enumeration Date | 2018-03-14 |
Last Update Date | 2024-09-10 |