| NPI | 1326402116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0102204998) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102204998) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2020-07-02 |