| NPI | 1407944655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: ID O-259) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: ID O-259) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2019-10-28 |