| NPI | 1104264845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R6648) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX BP10059956) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MT204706) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2024-11-19 |