| NPI | 1831202704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KS 0430480) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2000146088) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2015-03-05 |