| NPI | 1750572681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX N1310) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N1310) |
| 207QS0010X Family Medicine Sports Medicine (Licence: TX N1310) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2018-12-13 |