| NPI | 1194836676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: FL ME141780) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 200501013) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2005-01013) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-02-23 |