| NPI | 1750970265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 59917) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10072348) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2025-06-10 |