| NPI | 1861422032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: HI 15761) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01057690a) |
| 207L00000X Anesthesiology (Licence: NY 252923-1) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-08-06 |