| NPI | 1609214253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX S5111) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX S5111) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2023-08-08 |