| NPI | 1780092346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 007612) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q09806) |
| 208D00000X General Practice (Licence: TX Q9806) | |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2021-01-28 |