| NPI | 1316332166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A162556) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA A162556) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-03-14 |