| NPI | 1760524425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: OK 24374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24374) |
| 208M00000X Hospitalist (Licence: OK 24374) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2022-10-03 |