| NPI | 1609102508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A115302) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60344883) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2021-11-29 |