| NPI | 1255733531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS15192) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS15192) |
| 207Q00000X Family Medicine (Licence: FL OS15192) | |
| 208VP0000X (Licence: FL OS15192) | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2020-07-03 |