| NPI | 1699762914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 16535) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 09512) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2010-11-16 |