| NPI | 1609014117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: ID m7701) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: ID m7701) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2009-04-01 |