| NPI | 1093936049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA GA 026238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 026238) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2016-12-13 |