| NPI | 1245291863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 9700302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9700302) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-04-11 |