| NPI | 1336123827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD000040216) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD00040216) |
| 207R00000X Internal Medicine (Licence: WA MD00040216) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2023-02-09 |