| NPI | 1780002220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NM MD2015-0915) |
| Additional Taxonomies | 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: NM MD20150915) |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NM MD2015-0915) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: NM MD2015-0915) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2021-02-17 |