| NPI | 1386703403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI SC057395) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI sc057395) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2009-01-20 |