| NPI | 1033120852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: VA 0101268046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11013088) |
| 207QS0010X Family Medicine Sports Medicine (Licence: MN 55415) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: VA 0101268046) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 54712) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-03 |