| NPI | 1801089503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX M7476) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: TX M7476) |
| Enumeration Date | 2007-08-26 |
| Last Update Date | 2016-05-05 |