| NPI | 1104894336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A66743) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A66743) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2013-09-26 |