| NPI | 1255361838 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA G63429) | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA G63429) | 
| 208VP0000X (Licence: CA G63429) | |
| Enumeration Date | 2006-07-03 | 
| Last Update Date | 2025-06-03 |