| NPI | 1114938586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME32034) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME62034) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2023-11-30 |