| NPI | 1295081065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 3355) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 3355) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2021-03-22 |