| NPI | 1861410995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX L6694) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX L6694) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX L6694) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-09-19 |