| NPI | 1710005731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA G77719) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CA G77719) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |