| NPI | 1023167947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS685) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: HI DOS685) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2022-07-21 |