| NPI | 1659372290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX L3143) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX L3143) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2020-06-08 |