| NPI | 1174565568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2021-02628) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-02628) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2021-12-14 |