| NPI | 1043238553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX Q8294) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 227525) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WV 23594) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-12-19 |