| NPI | 1689661134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: AZ 11294) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 11294) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2009-08-20 |