| NPI | 1013088277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 49097-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49097) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2014-02-24 |