| NPI | 1194960658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX W2802) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX W2802) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 252485-1) | |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2025-12-17 |