| NPI | 1154532612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD433445) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA MD433445) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-07-21 |