| NPI | 1043690712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WV 29723) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT208963) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2021-04-22 |