| NPI | 1215148838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6182) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX M6182) |
| 207QS0010X Family Medicine Sports Medicine (Licence: TX M6182) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-07-28 |