NPI | 1750311726 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX L7309) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX L7309) |
Enumeration Date | 2006-07-04 |
Last Update Date | 2022-09-19 |