| NPI | 1235233586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD 040830-L) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA MD 040830-L) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2007-07-09 |