| 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 |