| NPI | 1588637490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX F3535) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX F3535) |
| 208D00000X General Practice (Licence: TX F3535) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2020-06-12 |