| NPI | 1154436889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME0057638) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME0057638) |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: FL ME0057638) | |
| 208D00000X General Practice (Licence: FL ME0057638) | |
| 207Q00000X Family Medicine (Licence: FL ME0057638) | |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL ME0057638) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME0057638) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME0057638) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: FL ME0057638) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME0057638) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-08-10 |