| NPI | 1922331412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 70812) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207L00000X Anesthesiology (Licence: TX Q4210) | |
| 207L00000X Anesthesiology (Licence: VA 0101248872) | |
| 207LC0200X Anesthesiology Critical Care Medicine (Licence: VA 0101248872) | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2022-02-09 |