| NPI | 1467959445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX T1988) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX T1988) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2024-07-02 |