| NPI | 1437149242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A86830) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CA A86830) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2017-11-16 |