| NPI | 1710628086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KS 94-11008) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO DR.77618) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2026-05-12 |