| NPI | 1639483969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS14281) |
| Additional Taxonomies | 208VP0000X (Licence: TX Q3271) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2026-06-26 |