| NPI | 1932586617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 328618) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A17249) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX S8186) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2021-08-26 |