| NPI | 1699791954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NV 1077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 1077) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-08-18 |