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 |