| NPI | 1912051012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: OR MD181903) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A61208) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-02-20 |