NPI | 1669665154 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: MI 4301062570) |
Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: MI 4301062570) |
2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: MI 4301062570) | |
Enumeration Date | 2007-08-20 |
Last Update Date | 2016-03-11 |