| NPI | 1235122698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C39397) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA C39297) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2015-06-16 |