| NPI | 1417125600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D0043563) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA G062996) |
| 207R00000X Internal Medicine (Licence: MD D0043563) | |
| 207R00000X Internal Medicine (Licence: CA G062996) | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2019-07-13 |