| NPI | 1013978626 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 05002807) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA 05002807L) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2007-07-08 |