| NPI | 1174686380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A112948) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD 60457554) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-11-06 |