| NPI | 1669829248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T7962) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 304739) |
| 207R00000X Internal Medicine (Licence: PA MT211331) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2025-11-26 |