NPI | 1194914614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA MD203634) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD203634) |
208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD203634) | |
Enumeration Date | 2007-10-22 |
Last Update Date | 2010-05-27 |