| NPI | 1881076891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX S2793) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.134144) |
| 207R00000X Internal Medicine (Licence: KS 94-08768) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2024-02-05 |