| NPI | 1972920270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R7352) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN 3764) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 3764) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX R7352) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2023-08-21 |