| NPI | 1750879466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD61384668) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD61384668) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2023-07-12 |