| NPI | 1174515522 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MO 2019009913)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 05-42050)  | 
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: KS 0542050)  | |
| Enumeration Date | 2005-08-19 | 
| Last Update Date | 2025-06-06 |