| NPI | 1548436934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX M9302) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: TX M9302) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2010-09-08 |