| NPI | 1417061391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD20060456) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NM MD2006-0456) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NM MD2006-0456) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2012-04-02 |