| NPI | 1821388562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T4427) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO DR.00057666) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NV 17333) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 60185) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 17333) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2026-08-04 |