| NPI | 1770804916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A158490) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101285321) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2025-04-24 |