| NPI | 1104139443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A132112) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL TRN# 14925) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2014-10-29 |