| NPI | 1003380429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA AP61080718) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 95035042) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2022-09-02 |