| NPI | 1831214535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA md040998l) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA md040998l) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2012-08-30 |