| NPI | 1477679892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD00017764) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00017764) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2021-03-31 |