| NPI | 1871524728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WA MD00041809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041809) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00041809) | |
| 171100000X Acupuncturist (Licence: WA MD00041809) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2021-06-02 |