| NPI | 1396158671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP60850605) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 9408333) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2025-05-06 |