| NPI | 1841812237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A198421) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207L00000X Anesthesiology (Licence: VA 0101273647) | |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2024-10-15 |