| NPI | 1114151347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WV TMP-02704) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 273568) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0077894) | |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2021-04-22 |