| NPI | 1104942887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NV 13797) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A90223) |
| 207L00000X Anesthesiology (Licence: CA A90223) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2015-02-05 |