| NPI | 1275111361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX W4741) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 334560) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX W4741) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2026-08-11 |