| NPI | 1467892919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NV DO1646) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1243) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NE 1243) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2021-05-17 |