| NPI | 1013960475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A69438) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 219901) |
| 207R00000X Internal Medicine (Licence: CA A69438) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2015-03-02 |