| NPI | 1073179842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 97914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 30373) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-12-28 |