| NPI | 1689881955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60550671) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD.60550671) |
| 207L00000X Anesthesiology (Licence: CA 101019) | |
| 208D00000X General Practice (Licence: CA A101019) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2017-01-26 |