| NPI | 1467959445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T1988) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX T1988) |
| 208VP0000X (Licence: TX T1988) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-04-21 |