| NPI | 1942429675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2013-01484) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101240347) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2017-02-28 |