| NPI | 1427053289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 33216) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 33216) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2007-07-08 |