| NPI | 1720156490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A26350) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A26350) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2025-08-06 |