| NPI | 1619097813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KS 94-06244 temporary) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 04-33141) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2014-07-18 |