| NPI | 1619125390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 8491) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL OS8194) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2023-09-21 |