| NPI | 1538166715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A83047) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 44785-020) |
| 207L00000X Anesthesiology (Licence: NV 10912) | |
| Enumeration Date | 2005-07-04 |
| Last Update Date | 2022-05-09 |