| NPI | 1982863536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A110103) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME113345) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: FL ME113345) | |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2020-05-10 |