| NPI | 1003998329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN MD18524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD18524) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: TN MD18524) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2015-07-16 |