| NPI | 1992749303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA G56342) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 40528) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-03-01 |