| NPI | 1013302140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WV 28482) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 28482) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WV 28482) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2021-11-30 |