| NPI | 1386696003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 53179) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 36065355) |
| 207Q00000X Family Medicine (Licence: WI 53179) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2022-07-21 |