| NPI | 1760514343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A45536) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A45536) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A45536) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A45536) | |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2007-07-09 |