| NPI | 1215904198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A102650) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301085094) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2011-02-09 |