| NPI | 1104056076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KS 9407235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9407235) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2010-07-01 |