NPI | 1881252229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME155152) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME155152) |
207Q00000X Family Medicine (Licence: WA MD61474283) | |
Enumeration Date | 2019-05-31 |
Last Update Date | 2023-11-07 |