| NPI | 1154322618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00044648) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A90623) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2021-07-16 |