| NPI | 1669400362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102036817) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0102036817) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102036817) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0102036817) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2014-02-07 |