| NPI | 1609845700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: CA C31808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C31808) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: CA C31808) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-09 |