| NPI | 1154524668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M3258) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M3258) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX M3258) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2020-07-21 |