| NPI | 1538361530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101015984) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: MI 5101015984) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-06-29 |