| NPI | 1922015395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 54132) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 35.077033) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-07-21 |