| NPI | 1649262635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 34998) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: IA 03083) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-03-03 |