| NPI | 1740920131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 14279445-1205) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: UT 14279445-1205) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2026-07-08 |