| NPI | 1558388454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME42998) |
| Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: FL ME42998) |
| 208D00000X General Practice (Licence: FL ME42998) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2019-09-30 |