| NPI | 1992018253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OK 28000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 64188) |
| 207Q00000X Family Medicine (Licence: WA MD61351065) | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2024-07-19 |