| 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 |