NPI | 1376855999 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 90571) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116023039) |
207Q00000X Family Medicine (Licence: GA 90571) | |
Enumeration Date | 2010-07-12 |
Last Update Date | 2022-06-06 |