| NPI | 1730677196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX U5723) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX U5723) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2025-07-18 |