| NPI | 1134284383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 5799) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA )T010607) |
| 208D00000X General Practice (Licence: CA 20A12768) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NH 14304) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2019-02-17 |