| NPI | 1356705677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ACN929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 019299) |
| 208D00000X General Practice (Licence: FL ACN979) | |
| 208D00000X General Practice (Licence: PR 019299) | |
| 261QP3300X Clinic/Center, Pain (Licence: FL PMC1840) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2024-08-02 |