| NPI | 1083677421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 32171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 32171) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 32171) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2021-07-19 |