| NPI | 1659639631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102204264) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102204264) |
| 261QC1500X Clinic/Center, Community Health (Licence: VA 0102204264) | |
| 261Q00000X Clinic/Center (Licence: VA 0102204264) | |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0102204264) | |
| 261QP3300X Clinic/Center, Pain (Licence: VA 0102204264) | |
| 261QR0800X Clinic/Center, Recovery Care (Licence: VA 0102204264) | |
| 207Q00000X Family Medicine (Licence: VA 0102204264) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0102204264) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0102204264) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: VA 0102204264) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0102204264) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2015-10-14 |