| NPI | 1104822659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX J2823) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX J2828) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX J2823) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2020-04-27 |