| NPI | 1205833654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD 012556-E) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD 012556-E) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2007-07-09 |