| NPI | 1902291362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX R3129) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX R3129) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2024-05-01 |