| NPI | 1902292105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX R8524) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R8524) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX R8524) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2023-03-30 |