| NPI | 1477667053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OR MD18811) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD18811) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-05-16 |