| NPI | 1073701173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD60321448) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60321448) |
| 208D00000X General Practice (Licence: CA A101269) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2020-12-08 |