| NPI | 1992090955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P6717) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: TX P6717) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2025-06-26 |