| NPI | 1568826964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: CA A171445) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A171445) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2026-05-01 |