| NPI | 1548525611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A131338) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3201001683) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: CA A131338) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-10-05 |