| NPI | 1184313934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA 70131025) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA 70131025) |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2026-07-24 |