| NPI | 1790340701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AK 201152) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA A176880) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2023-07-25 |