| NPI | 1164442778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX L8122) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX L8122) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX L8122) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX L8122) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-03-01 |