| NPI | 1467427054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX K5755) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: TX K5755) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX K5755) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX K5755) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2022-07-21 |