| NPI | 1235237454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME98460) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301067176) |
| 207R00000X Internal Medicine (Licence: FL ME98460) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME98460) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME98460) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-08-14 |