| NPI | 1760478697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA OS002340L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP024664L) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2021-01-22 |