| NPI | 1619554201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 7491686-1205) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 7491686-1205) |
| 204R00000X Electrodiagnostic Medicine (Licence: UT 7491686-1205) | |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: UT 7491686-1205) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 7491686-1205) | |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2026-07-22 |