| NPI | 1801875448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA C180855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 11313) |
| 207Q00000X Family Medicine (Licence: UT 5553839-1205) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2023-01-25 |