| NPI | 1306475470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: AR E-16590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-16590) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2023-11-15 |