| NPI | 1104836832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX L2151) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX L2151) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OH 34008248) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2022-07-21 |