| NPI | 1467080622 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T7700) | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 11010) | 
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX t7700) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-31 | 
| Last Update Date | 2025-06-20 |