| NPI | 1013924232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AL D0199) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO199) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AL DO199) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: AL D0199) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-02-27 |