| NPI | 1881088052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX S2377) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: TX S2377) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX S2377) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2023-02-23 |