| NPI | 1982065561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T2307) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102205924) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2022-04-07 |