| NPI | 1073670873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: CO 21657) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: MT 9742) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: CO 21657) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2010-02-22 |