| NPI | 1750851390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH MICHAEL MILLER Provider 215-433-1575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 2084N0400X Psychiatry & Neurology Neurology | |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |