| NPI | 1659330504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX P5016) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 54-12703-1205) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2023-06-29 |