| NPI | 1730614470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: IN 02006430A) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IN 02006430A) |
| 207R00000X Internal Medicine (Licence: PA OT017655) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2021-09-28 |