| NPI | 1720179401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MS 18248) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 18248) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-10-04 |