| NPI | 1265593453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: SC 51925) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD.28167) |
| 207R00000X Internal Medicine (Licence: AL MD.28167) | |
| 208M00000X Hospitalist (Licence: AL MD.28167) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AL MD.28167) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-02-25 |