| NPI | 1104045970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KS 05-34840) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 946257) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2013-04-25 |