| NPI | 1326028440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E2493) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: AR E2493) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: AR E2493) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2013-07-24 |