| NPI | 1801830815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AL PM.552) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 15438) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2018-01-29 |