| NPI | 1912394412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 17559) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 17559) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2020-05-17 |