| NPI | 1841291077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 042956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 042956) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2019-08-22 |