| NPI | 1629026307 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 114277)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 0529166)  | 
| Enumeration Date | 2006-05-04 | 
| Last Update Date | 2007-07-09 |