| NPI | 1942748678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: TX PA133012) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX PA133012) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP133012) | |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2023-01-23 |