| NPI | 1982299806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A180263) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2026-05-04 |