| NPI | 1013657055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A25951) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM RS2022-0545) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-09-24 |