| NPI | 1508270539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX R2982) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX R2982) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2025-11-20 |