| NPI | 1326051962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OR OR MD08504) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA WA MD00013804) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OR OR MD08504) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WA WA MD00013804) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |