| NPI | 1760524573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WY 7633A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 37896) |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: AZ 37896) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 37896) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2016-02-05 |