| NPI | 1821258559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101246468) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2020-10-13 |