| NPI | 1649211285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA C36871) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX E0863) |
| 208D00000X General Practice (Licence: CA C36871) | |
| 207L00000X Anesthesiology (Licence: TX E0863) | |
| 208D00000X General Practice (Licence: TX E0863) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-02-22 |