| NPI | 1710488614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: RI LP05895) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2023-05-08 |