| NPI | 1912111956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A101905) |
| Additional Taxonomies | 207LC0200X Anesthesiology Critical Care Medicine (Licence: CA A101905) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: CA A101905) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2019-12-26 |