| NPI | 1972893790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A108866) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A109866) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2024-07-09 |