| NPI | 1750348637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD-039454E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD039454E) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2011-03-16 |