| NPI | 1588126130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 83497-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 0448320) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-08-29 |