| NPI | 1376930891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61053509) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 160746) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2025-03-20 |