| NPI | 1215040001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A8513) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A8513) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA 20A8513) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2010-11-23 |