| NPI | 1184992265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME126007) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME126007) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2024-07-12 |