| NPI | 1215340146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5960484-1205) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NE 29353) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: UT 12275004-1202) | |
| 208D00000X General Practice (Licence: UT 12275004-1202) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 5960484-1205) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2024-03-15 |