| NPI | 1073654984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 87687) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 87687) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX N6704) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD P21526) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX N6704) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2023-05-09 |