| NPI | 1487687331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 032101) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 032101) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-05-13 |