| NPI | 1205890027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NV 11588) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PA MD033724E) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NV 11588) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: UT 6968998-1205) | |
| 207P00000X Emergency Medicine (Licence: MO 2009007880) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2014-02-24 |