| NPI | 1467508663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: OH 35.133805) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: PA MD430105) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WV 23588) | |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2021-12-27 |