| NPI | 1285992065 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME122972) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME122972) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2025-02-11 |