| NPI | 1285610501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA g72968) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX J4835) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2023-12-13 |