| NPI | 1942314356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX L9727) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX L9727) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-07-21 |