| NPI | 1104111012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME128648) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: FL ME128648) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2021-09-24 |