| NPI | 1609284751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AL MD33195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.33195) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2019-04-15 |