| NPI | 1093707358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G34475) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA G034475) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G034475) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2016-07-22 |