| NPI | 1134284177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS4539) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: FL OS004539) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL OS004539) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2010-12-10 |