| NPI | 1518156140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KS 9408365) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2523) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2014-06-19 |