| NPI | 1174526180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD426812) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA XT4563777) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2018-10-29 |