| NPI | 1033152954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 27247) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 27247) |
| 208D00000X General Practice (Licence: GA 27247) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 27247) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-07-09 |