| NPI | 1033550819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KS KS440687) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2013014922) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2018-07-19 |