| NPI | 1073714580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 55824) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 55824) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 55824) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2021-12-01 |