| NPI | 1255594206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME122552) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME122552) |
| 208100000X Physical Medicine & Rehabilitation (Licence: DC MD040855) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-07-21 |