| NPI | 1578848792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MO 2015011363) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102203750) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2015011363) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10040290) | |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2020-10-13 |