| NPI | 1669681938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MA 52228) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MA 52228) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |