| NPI | 1164910592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OK 33843) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 33843) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2024-07-24 |