| NPI | 1598989170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2007020222) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 94-05927 temporary) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2016-12-06 |