| NPI | 1710142484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX n0671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX n0671) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX n0671) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2024-02-20 |