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 |