| NPI | 1679579817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: CA C136636) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA C136636) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2026-01-30 |