| NPI | 1982967675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX S7680) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX S7680) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA 201113) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 60237) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2025-06-09 |