| NPI | 1528103553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME56492) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME56492) |
| 208D00000X General Practice (Licence: FL me56492) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL me56492) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-04-03 |