| NPI | 1639268345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX L1710) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: TX L1710) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2026-05-18 |