| NPI | 1336330596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN MD53546) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN MD53546) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2023-02-07 |