| NPI | 1700810603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: WV 20316) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WV 20316) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-01-30 |