| NPI | 1992470439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 2886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO PA.0006843) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CO PA.0006843) | |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2023-10-10 |