| NPI | 1902550569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 206826) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2023016072) |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2026-05-07 |