| NPI | 1699762161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD00018334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00018334) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2015-12-16 |