| NPI | 1518011451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301066542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301066542) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301066542) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2011-01-12 |