NPI | 1235237538 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 37064) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52383) |
208VP0000X Pain Medicine, Pain Medicine (Licence: WI 37064) | |
Enumeration Date | 2006-09-20 |
Last Update Date | 2018-10-13 |