| NPI | 1609047109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WV 2195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2195) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2022-08-24 |