| NPI | 1063414225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KS 0429750) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 0429750) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-12-05 |