| NPI | 1740364512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CO 29963) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 29963) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-03-07 |