| NPI | 1831136811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 98009818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 98009818) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-12-14 |