| NPI | 1154636645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A11870) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2562) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2020-02-06 |