| NPI | 1861424210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WV 17647) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101053793) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0101053793) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: WV 17647) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-01-03 |