| NPI | 1518098409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 38981) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: GA 38981) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2015-07-31 |