| NPI | 1861668493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: TX N9340) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX N9340) |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2020-01-30 |