| NPI | 1649274317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: IN 01045681A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01045681A) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 01045681) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2020-04-17 |