| NPI | 1710301205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME114798) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME114798) |
| 207QS0010X Family Medicine Sports Medicine (Licence: FL ME114798) | |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2023-05-19 |