| NPI | 1497718688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: TX K0608) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX K0608) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: TX K0608) | |
| 207R00000X Internal Medicine (Licence: TX K0608) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2007-07-08 |