| NPI | 1104074046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME102638) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME54328) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME102638) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME102638) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2022-01-28 |