| NPI | 1770708554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A98380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A98380) |
| 207L00000X Anesthesiology (Licence: MA 232721) | |
| 207R00000X Internal Medicine (Licence: MA 232721) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-04-29 |