| NPI | 1609304302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A173748) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT213294) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2025-03-12 |