NPI | 1659699460 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME167163) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32551) |
207Q00000X Family Medicine (Licence: CT 54678) | |
208VP0000X Pain Medicine Pain Medicine (Licence: FL ME167163) | |
Enumeration Date | 2010-05-05 |
Last Update Date | 2024-09-17 |