| NPI | 1124034673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0054330) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME0054330) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME0054330) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-01-14 |