| NPI | 1326225350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WV 2272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2274) |
| 208D00000X General Practice (Licence: WV 2272) | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2022-08-24 |