| NPI | 1992331912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX W0284) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-49784) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX W0284) | |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2025-10-10 |