| NPI | 1134176142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA BE8901060) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PA MD427825) |
| 208D00000X General Practice (Licence: PA MD427825) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2016-03-07 |