| NPI | 1104017391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME112876) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: TX BP1-0028968) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME112876) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-09-03 |