| NPI | 1487630109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: CA G53654) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA G53654) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2017-05-02 |