| NPI | 1063490852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME 86760) |
| Additional Taxonomies | 208VP0000X (Licence: FL ME 86760) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME 86760) | |
| 208D00000X General Practice (Licence: FL ME86760) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2025-01-29 |