| NPI | 1871568642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A14694) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 245346) |
| 207Q00000X Family Medicine (Licence: VA 0102201633) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2024-06-10 |