| NPI | 1932417094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 66950) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 66950) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2014-03-26 |