| NPI | 1730716713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 13891972-1204) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 13891972-1204) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-07-18 |