| NPI | 1013996503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WV WV1480) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WV WV1480) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2011-11-21 |