| NPI | 1851399117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0101051008) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0101051008) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2021-05-26 |