| NPI | 1790913739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX T0883) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10036279) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T0883) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2023-06-27 |