| NPI | 1376780387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 73433) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX R8877) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX R8877) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX R8877) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A126856) | |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2023-02-15 |