| NPI | 1912448564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 135031) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: CA 135031) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2021-12-03 |