| NPI | 1568410397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX P6453) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX P6453) |
| 225100000X Physical Therapist (Licence: TX 1231070) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-10-11 |