| NPI | 1891795688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WV 34724) |
| Additional Taxonomies | 208VP0000X (Licence: WV 34724) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2025-05-12 |