| NPI | 1235372012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NM 446RX2) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NM 446RX2) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NM 446RX2) | |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-05-11 |