| NPI | 1598773244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL PMC1827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M8195) |
| 207Q00000X Family Medicine (Licence: CA 129554) | |
| 207Q00000X Family Medicine (Licence: NY 270876) | |
| 207Q00000X Family Medicine (Licence: FL ME 96210) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2022-07-27 |