| NPI | 1871792838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN DO2786) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2022-03-31 |