| NPI | 1821384975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: KS 04-39326) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA R-10248) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2017-04-03 |