| NPI | 1295804748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD00026919) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA MD00026919) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00026919) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2015-10-30 |