| NPI | 1114157450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A116417) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2013-00776) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2026-07-01 |