| NPI | 1912102278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J3640) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: TX J3640) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: TX J3640) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2015-01-05 |