| NPI | 1881648186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 29268) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 29268) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2024-07-19 |