| NPI | 1396206314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 43499) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: AL 43499) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2024-01-23 |