| NPI | 1356798904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2020012205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 94-08870) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2020-07-06 |