| NPI | 1154311041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0102036933) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102036933) |
| 207Q00000X Family Medicine (Licence: VA 0102036933) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2010-08-23 |