| NPI | 1104137769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A12107) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CA 20A12107) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2015-11-16 |